Provider Demographics
NPI:1861931826
Name:LIGHT OF LIFE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:LIGHT OF LIFE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ULISES
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC, LPC, LMFT
Authorized Official - Phone:623-628-8788
Mailing Address - Street 1:51 E MONROE AVE UNIT 1291
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-7551
Mailing Address - Country:US
Mailing Address - Phone:623-628-8788
Mailing Address - Fax:928-286-5158
Practice Address - Street 1:6500 S MILLER RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1503
Practice Address - Country:US
Practice Address - Phone:623-628-8788
Practice Address - Fax:928-286-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 106H00000X
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty